Have severe pain? It’s quite unlikely you’ll get addicted to opioids

Obviously, opioid addiction is a very serious problem that we should treat very seriously. That said, misinformation on the matter is not particularly helpful. And for the substantial majority of users opioids are not some incredibly addictive monster that once you start using them for that back pain, post-surgery pain, etc., dooms you to a horrible addiction.

Yes, the drug companies irresponsibly and reprehensibly misused the legitimate concern that pain was being undertreated to sell massive amounts of product. Yes, Purdue Pharma inaccurately claimed that Oxycontin was a less addictive opioid—and that its effects lasted longer than they really did. Yes, salespeople pressured many doctors into prescribing far more than made sense.

“The simple story is that addiction happens all the time when people get opioids for pain and that simple story is clearly wrong,” says Stefan Kertesz, associate professor of preventive medicine at the University of Alabama.

The research actually shows that people who developed new addictions in recent years were overwhelmingly not pain patients. Instead, they were mainly friends, relatives, and others to whom those pills were diverted—typically young people. Among the older patients, many who appeared to be newly addicted had actually relapsed or never recovered from prior addictions: [emphasis mine] some faked pain to get pills from well-meaning doctors; others got them from pill mills where shady physicians wrote prescriptions for cash…

So, what is the real risk to pain patients from being prescribed opioids? This is a hotly debated topic, with the Centers of Disease Control and Prevention and news media being fond of saying that “up to 26 percent” of people exposed become addicted. This is pretty much the scariest figure available, but note that this means that nearly three-quarters don’t get hooked.

But this number cannot possibly be accurate. Some 70 percent of the population is exposed to medical opioids during their lifetime. If 26 percent of these people became addicted, we’d expect to see tens of millions of people with opioid addiction and hundreds of thousands of overdose deaths. The true addiction figure is roughly 2.5 million, or about 1 percent of the adult population, and the actual number of fatalities is horrifying enough, but it was just around 33,000 deaths in 2015…

Moreover, among patients who just take opioids short-term—such as those who have acute pain from surgery or dental work—studies find that the risk is even lower. For example, one study of more than 640,000 surgical patients who had never previously taken opioids found that few used the drugs for more than three months after recovery from surgery: rates varied from less than 0.12 percent for people who had C-sections up to 1.4 percent for those who had knee surgery. And keep in mind that most of this long-term use—as we can see from the other studies—isn’t addiction, just pain treatment…

Nonetheless, the idea that patients who take medications as prescribed are the cause of this problem is inaccurate. While the media loves to highlight “innocent victims” who became addicted through medicine, the fact is that this group is a minority. Medical use surely increased access to the drugs—but the people who got hooked tended to do so while using medication that was either prescribed for someone else or otherwise distributed illegally. [emphasis mine]

The point here is not to stigmatize those addicted to opioids, or to pretend that opioid addiction isn’t a real problem (one we could address so much more smartly), but using mis-leading narratives to address genuine public health and public policy problems doesn’t help anybody.